Bill & Melinda Gates Foundation

Presidential Campaigning and Promoting a Health behavior: What Do These Have in Common?

February 05, 2013

What do running a presidential campaign and promoting healthy behaviors have in common?  Reflecting on President Obama’s inauguration, the Alive & Thrive (A&T) project (which works to improve infant and young child nutrition by promoting exclusive breastfeeding and complementary feeding, and managed by FHI 360) has some thoughts.

Being precise about which behavior you need to promote

Obama’s door-to-door canvassing effort during the recent presidential campaign was said to have a clear behavioral objective: Make sure that likely Democrat voters go to the polls and vote. Rather than knocking on all doors to persuade undecided voters to support Obama, canvassers contacted people who had already indicated they were pro-Obama.

We used similar thinking to choose the breastfeeding behavior to promote. In Viet Nam, most mothers already said they know that breastfeeding is best. But it didn’t occur to mothers that when they give the baby water it means that they aren’t getting the benefit of exclusive breastfeeding for 6 months. To increase the percentage of mothers practicing exclusive breastfeeding, one of our TV spots focuses on the specific behavior “don’t give the baby water.”

In an A&T TV spot in Viet Nam, a “talking” baby shares the precise behavior
that results in exclusive breastfeeding.

Making it feel easy to do the behavior

Obama’s strategists reportedly acted on the insight from behavioral economists that people are more likely to act when the action seems easy to do. Some U.S. states passed new regulations requiring people to show valid photo identification (ID) in order to vote, leaving many people confused or fearful about voting. When campaign volunteers in the state of Virginia were educated on which types of IDs were acceptable, they were advised to avoid complicated discussions of what is and isn’t a valid ID. Instead, they were told to simply get out the message, “It’s EASY to vote in Virginia.”

Similarly, in Bangladesh, A&T focused on making it seem easy for mothers to adopt an essential behavior: washing their hands with soap and water before preparing food or feeding a baby. Studies in Bangladesh showed that a major reason busy mothers found it hard to wash their hands before handling a baby’s food was that there was no soap and water nearby. We learned that mothers were much more likely to wash their hands the right way and at the right time if soap and water were readily available. The project’s handwashing campaign, based on our behavioral trials and other formative research, encouraged families to keep a handwashing station with soap and water near the child’s feeding place.

A TV spot from A&T’s handwashing campaign in Bangladesh reminds families to
keep soap and water near the child’s feeding place.

Asking people to make a plan for how they will adopt the behavior

By analyzing data from previous elections, Obama’s strategists were reported to have seen that people who made a specific plan to get to the polls on Election Day were more likely to vote. During face-to-face or phone conversations, campaign workers asked potential voters, "What time of day do you plan to vote?" Campaign documents estimated that helping people pin down a personal plan could increase voting by 4 percentage points, and in a close race, that can make the difference.

The same strategy is being used to encourage mothers to breastfeed within the first hour of life. A&T staff helped the Mobile Alliance for Maternal Action (MAMA) – which delivers vital health information to pregnant women and new mothers through text messages on their mobile phones – refine its messages. For example, the original version of a message sent to women in their 19th week of pregnancy simply advised early initiation of breastfeeding. A&T advisors suggested asking mothers to make a personal plan for starting breastfeeding. Now the message reads, “Make a plan with your family to put your new baby to the breast in the first hour. The creamy first milk will help protect him from illness.”

Just as political campaigns are applying practical findings from behavioral science, more programs that strive to help people adopt better health behaviors are doing the same, whether through face-to-face counseling, mass media, or text messages and other technology. 

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